Structure level

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Structural level is a term used in psychoanalysis that was coined by Heinz Kohut as part of the self-psychology he developed , and which emerged in the 1960s and 1970s as a further development of classical psychoanalysis. The psychoanalytic object relationship theories also use the term.

The determination of the structural level of a personality allows an expanded description of mental disorders , going beyond the conflict pathology - i.e. the inability to adequately resolve unconscious conflicts . The distinction between high , medium and low structural level goes back to Kernberg , which describes a different level of development or degree of maturity of the psychological functions and personality structure of a person. As Structural disorders mental disorders are referred to, in which the availability is limited on mental functions necessary for the organization of the self and its relationships with internal and external objects are required, usually in early childhood as a result of relationship problems. The description of the structural level of a personality and the diagnosis of structural pathologies, as developed, for example, in Operationalized Psychodynamic Diagnostics (OPD), represents an important basis for current psychodiagnostics.

Aspects of the structural level

According to OPD -1, the following six structural dimensions are important for psychodiagnostics in general, but also for structural disorders :

  • Self-perception: As the ability to perceive yourself as your own “self” and to be able to look at yourself critically, to look inside yourself and to be able to recognize different feelings.
    (Self-reflection, self-image , identity , affect differentiation )
  • Self-control: As the ability to control one's own needs, feelings and self-esteem .
    (Affect tolerance, self-esteem regulation, impulse control, anticipation )
  • Defense (see also defense mechanism ): As the ability to maintain the mental balance in conflicts through one's own protective and defense mechanisms.
    (Internal versus interpersonal defense, flexibility of defense)
  • Object perception : As the ability to reliably differentiate between inner and outer reality, empathy , to perceive other people holistically and as having their own rights.
    (Self-object differentiation, empathy, holistic object perception, object-related affects)
  • Communication: As the ability to approach others, to understand them, to communicate with them and to understand emotional signals.
    (Establishing contact, understanding affects , communicating affects, reciprocity )
  • Bonding: As the ability to establish inner representations of the other and to occupy them with feelings in the long term, to loosen bonds and the ability to adjust to bonds that do not run evenly.
    ( Internalization , detachment, variability of attachment )

Differentiation of the structure level

When operationalized psychodynamic diagnostics (OPD) four levels of structural integration can be distinguished:

  • Disintegrated structural level: The disintegration is ascribed to the “structural pathology ”, which is considered a serious disorder. It is the result of major interaction disruption in the early sensory phase and individuation . Ego functions with differentiating and integrative skills are poorly developed and the basic skills of self and relationship regulation show deficits. Non-integrated parts of self and object are present and lead to changing self-states and the relation to reality is unstable. The resilience to affects, impulses, interpersonal tensions and problems is low. The preferred defense mechanism is splitting .
    (Clinically often as borderline personality disorder )
  • Low integrated structure level (also low structure level): This intermediate area relates to disorders that occur in the threshold phase of the development of autonomy and are predominantly presented as a "conflict pathology". The ego functions are reasonably intact, but self-object representations are moderately integrated. The preferred defense mechanism is idealization or devaluation, which, in terms of maturity, stands between division and repression .
    (Depressed and self-esteem pathology or depressed personality)
  • Moderately integrated structure level (also medium structure level): The moderately integrated structure level is overcome with the completion of the individualization development. If developmental disorders occur in the following phase, it is no longer the severe structural, but the lighter “conflict pathologies”.
The ego has developed a relative maturity and stable functioning with well-integrated self-object representations. The preferred defense mechanism is repression.
(More mature, "classic" neuroses)
  • Well integrated structural level (also mature or high structural level): People can achieve a well integrated structural level if no lasting developmental disorders have occurred. In the event of late trauma or stress, such people can also develop disorders which, however, are more accessible to treatment. The preferred defense mechanism is sublimation .
    (Reactive or post-traumatic disorders)

Application of the structural level in psychotherapy practice

Even in the first interview, the psychotherapist should definitely get a clear picture of the self and ego organization, in particular the patient's self-control and interaction skills. For this purpose, the determination of the structure level in the sense of the structure axis of the OPD-2 designed by Gerd Rudolf is suitable . If the structural level is not determined, there is a risk of overestimating the patient and using unsuitable treatment strategies (for example, addressing overly unconscious aspects).

The therapist should get an idea of ​​which of the above-mentioned self-control and interaction skills (self-perception, self-control, defense, object perception, communication, attachment) are particularly problematic from his point of view. He should determine those deficits that seem to be responsible for the fact that the patient cannot cope with the current demands of his life in the desired way. In addition, the structure level enables the determination of which self-control and interaction skills are particularly well developed in a patient and could be used as a resource in treatment planning.

It could be, for example, that a patient has considerable difficulties with his impulse and self-control and poorly positive inner images of important others, but his ability to communicate emotionally and receive help is relatively well developed. Such a patient might be in good hands in a self-help group. It could be an important therapy goal to encourage and support this patient in creating a permanent social network in addition to the temporary therapy relationship in which he can find support and give himself.

literature

Print
  • Michael Ermann : Psychosomatic medicine and psychotherapy: a textbook on a psychoanalytic basis . 5th, revised. Ed., W. Kohlhammer Verlag, Stuttgart 2007, ISBN 978-3-17-019664-3 . (Pp. 87–115, Chapter 4: Psychoanalytic Development and Structural Diagnostics)
  • Gerd Rudolf : Structure-related psychotherapy: guidelines for the psychodynamic therapy of structural disorders . 2., revised. Ed., Schattauer Verlag, Stuttgart 2006, ISBN 978-3794525317 .
  • Ernest S. Wolf: Theory and Practice of Psychoanalytic Self-Psychology . Suhrkamp Verlag, Frankfurt am Main 1998, series: Suhrkamp-Taschenbuch Wissenschaft Nr. 1395, ISBN 3-518-28995-0 . (German translation; English original title: Treating the self )
  • Working group for the operationalization of psychodynamic diagnostics - Working group OPD (ed.): Operationalized Psychodynamic Diagnostics OPD-2: the manual for diagnostics and therapy planning . Huber Verlag, Bern 2006. ISBN 3-456-84285-6 .
  • Udo Boessmann, Arno Remmers: The first interview , Deutscher Psychologen Verlag, Bonn, 2011
On-line

Individual evidence

  1. ↑ Heinz Kohut: The healing of the self . 1st edition (reprint; German edition was revised and supplemented by the author), Frankfurt am Main 2002, series: Suhrkamp-Taschenbuch Wissenschaft No. 373, ISBN 3-518-27973-4 . (German translation; English original title: The restoration of the self ).
  2. ^ Gerd Rudolf: Notes on structure-related psychotherapy. September 14, 2014, accessed on March 23, 2018 : "These topics are now a self-evident part of therapeutic training and practice in guideline psychotherapy and in-patient treatment."
  3. ↑ Udo Boessmann, Arno Remmers: The first interview. Deutscher Psychologen Verlag, Bonn, 2011.